CEREBROSPINAL FLUID MARKERS OF ALZHEIMER’S-RELATED PATHOLOGY RELATE TO AMCI AMONG PEOPLE WITH HIV

Abstract Older people with HIV (PWH) are at-risk for Alzheimer’s disease (AD) and its precursor, amnestic mild cognitive impairment (aMCI). Identifying aMCI among PWH is challenging because memory impairment is also common in HIV-associated neurocognitive disorders (HAND). To investigate the utility of CSF AD pathology markers in differentiating aMCI from HAND, we assessed how these markers differentially relate to aMCI versus HAND status among PWH. Participants included 74 PWH (Mean age=48 [SD=8.5]; 87.4% male, 56.5% White) from the National NeuroAIDS Tissue Consortium who completed a neurocognitive test battery assessing seven cognitive domains and had CSF biomarker data for Aβ42, p-tau181, p-tau181/Aβ42 ratio, Neopterin and NfL. aMCI was defined as impairment (<1.0 SD below normative mean) on ≥2 memory outcomes among learning, delayed recall and recognition with at-least one recognition impairment required. HAND was defined as impairment (<1.0 SD below normative mean) in ≥2 cognitive domains. Separate linear regression models adjusting for demographic and HIV-related characteristics were used to examine how individual biomarkers relate to diagnostic status. Fifty-eight percent of participants were diagnosed with HAND, 50.5% were diagnosed with aMCI. CSF p-tau/Aβ42 ratio levels were higher (indicative of greater pathology) in PWH with versus without aMCI (β=.363, p=.001), but did not differ by HAND status. No other AD biomarker significantly differed by group status. Results indicate that the CSF p-tau181/Aβ42 ratio relates specifically to an aMCI-like profile among PWH, and, thus, may contribute to disentangling aMCI from HAND and informing the need for further diagnostic procedures.

Although people living with HIV are living longer than ever before, significant HIV-related physical and mental health disparities remain among older adults living with HIV (OALWH) due to issues related to advanced aging.HIVassociated neurocognitive disorders (HAND) are becoming increasingly common and have the potential to negatively impact the cognitive, motor, and psychological well-being of OALWH.However, more research on both predictors of HAND and interventions to support cognitively impaired OALWH is needed.This symposium offers insights along the spectrum of intervention development.Two presentations will focus on best identifying predictors of HAND among groups most at-risk up while the other three discuss tailoring and evaluating interventions to alleviate HAND-related symptoms within diverse samples of OALWH from across the country.The first presentation centers on how cerebrospinal fluid markers of Alzheimer's-related pathology can disentangle diagnosing HAND and amnestic mild cognitive impairment among OALWH in Southern California while the second highlights the role of grip strength in predicting frailty and cognitive impairment among OALWH living in South Florida.The third presentation assesses the feasibility, acceptability, and preliminary intervention effects of a physical activity intervention on cognition adapted for Latino OALWH in South Florida while the fourth examines qualitative feedback from several focus groups on adapting cognitive remediation group therapy as a hybrid group intervention for OALWH with cognitive concerns living in two Canadian provinces.Finally, the last presentation reviews findings of a 2-year randomized clinical trial examining speed of processing training on everyday functioning among OALWH in the U.S. Deep South.

HEALTH PROMOTION TO PREVENT AND REDUCE COGNITIVE DECLINE IN LATINOS LIVING WITH HIV/AIDS
Elliott Weinstein 1 , Marcela Kitaigorodsky 2 , Victoria Behar-Zusman 1 , and Daniel Jimenez 3 , 1. University of Miami,Miami,Florida,United States,Hollywood,Florida,United States,3. University of Miami Miller School of Medicine,Miami,Florida,United States Older Latinos living with HIV (LWH) are at increased risk for earlier onset of aging-related cognitive decline.HIVrelated cognitive impairments are observed in several domains including memory, reasoning/executive functioning, and speed of processing.Depression, a known neurocognitive risk, has been reported at five times the level among older Latinos LWH than in the general population, and older Latinos LWH are more likely to be sedentary, and not as actively engaged in pursuing changes in physical activity compared to their non-Latino White counterparts.Thus, this is a population that is particularly vulnerable to cognitive decline due to multiple risk factors.The aim of this study is to assess feasibility, acceptability, and preliminary intervention effects on cognition of the Happy Older Latinos are Active (HOLA) health promotion intervention.Thirty Latinos living with HIV with a mean age of 61.6 years (SD=6.1)were enrolled in a pilot single-arm trial.Participants were assessed at two time points on measures of cognitive and psychosocial functioning as well as biomarkers of cognition.In 7 months, we met our enrollment target with <5% of eligible participants refusing participation.Participants attended over 70% of sessions and 3 participants were lost to follow up.These results indicate that HOLA is an innovative health promotion program that is uniquely tailored to address the multiple concerns that are prevalent in this community in a nonstigmatizing and culturally acceptable manner.
Older people with HIV (PWH) are at-risk for Alzheimer's disease (AD) and its precursor, amnestic mild cognitive impairment (aMCI).Identifying aMCI among PWH is challenging because memory impairment is also common in HIV-associated neurocognitive disorders (HAND).To investigate the utility of CSF AD pathology markers in differentiating aMCI from HAND, we assessed how these markers differentially relate to aMCI versus HAND status among PWH.Participants included 74 PWH (Mean age=48 [SD=8.5];87.4% male, 56.5% White) from the National NeuroAIDS Tissue Consortium who completed a neurocognitive test battery assessing seven cognitive domains and had CSF biomarker data for Aβ42, p-tau181, p-tau181/ Aβ42 ratio, Neopterin and NfL.aMCI was defined as impairment (<1.0 SD below normative mean) on ≥2 memory outcomes among learning, delayed recall and recognition with at-least one recognition impairment required.HAND was defined as impairment (<1.0 SD below normative mean) in ≥2 cognitive domains.Separate linear regression models adjusting for demographic and HIV-related characteristics were used to examine how individual biomarkers relate to diagnostic status.Fifty-eight percent of participants were diagnosed with HAND, 50.5% were diagnosed with aMCI.CSF p-tau/Aβ42 ratio levels were higher (indicative of greater pathology) in PWH with versus without aMCI (β=.363, p=.001), but did not differ by HAND status.No other AD biomarker significantly differed by group status.Results indicate that the CSF p-tau181/Aβ42 ratio relates specifically to an aMCI-like profile among PWH, and, thus, may contribute to disentangling aMCI from HAND and informing the need for further diagnostic procedures.

COGNITIVE IMPAIRMENT, FRAILTY, AND GRIP FORCE GENERATION IN PEOPLE LIVING WITH HIV
Kaitlyn Dillon 1 , Bonnie Levin 2 , and Roger McIntosh 1 , 1. University of Miami, Miami, Florida, United States, 2.

University of Miami miller school of medicine, Miami, Florida, United States
People living with HIV (PLWH) face an earlier onset and higher rates of geriatric syndromes, including frailty and cognitive impairment.Grip force, an index of frailty, is sensitive to cognitive decline, central nervous system integrity, and may independently predict adverse health outcomes.The current study evaluates frailty, weakness, and cognitive impairment, as well as the neural correlates of grip force as they predict cognitive impairment.PLWH aged 55+ (N = 26; M = 61.9,SD = 4.7; 53.8% female; 76.9% Black) completed an fMRI task in which they were asked to generate 0%, 20%, 50%, and 80% of their maximum force, a neuropsychological battery, and a physical assessment.Cognitive impairment was indexed using the Global Deficit Score (GDS).Per Fried's Frailty Phenotype, 3.8% of the sample was robust, 57.7% was pre-frail, and 38.5% was frail.Impairment in memory significantly predicted GDS, controlling for age (B = 0.3, t = 4.9, p < .001).Robust frailty status significantly predicted GDS, controlling for age (B = -1.1,t = -2.4,p < .05).Age was also a significant predictor of GDS, controlling for frailty status (B = -0.1,t = -2.7,p < .05).Weakness, as indexed by grip strength, predicted frailty (F = 4.5, p < .05).Additional analyses will be conducted to examine activation in brain regions germane to force generation during the fMRI task as a predictor of GDS.To our knowledge, this is the first study to examine neural correlates of grip force generation in PLWH.

ADAPTING COGNITIVE REMEDIATION GROUP THERAPY AS A HYBRID INTERVENTION FOR PEOPLE WITH HIV AND COGNITIVE CONCERNS
Andrew Eaton 1 , Jenny Hui 2 , Marvelous Muchenje 2 , Kate Murzin 3 , Soo Chan Carusone 4 , francisco Ibáñez-Carrasco 2 , Nuelle Novik 5 , and Sharon Walmsley 6 , 1. University of Regina,Saskatoon,Saskatchewan,Canada,2. University of Toronto,Toronto,Ontario,Canada,3. Realize,Toronto,Ontario,Canada,4. McMaster University,Hamilton,Ontario,Canada,5. University of Regina,Regina,Saskatchewan,Canada,6. University Health Network,Toronto,Ontario,Canada Cognitive impairment is a significant health issue for people aging with HIV/AIDS.With pharmacological treatment lacking, psychosocial group therapies may best help people aging with HIV and cognitive challenges cope with symptoms.The COVID-19 pandemic demonstrated how in-person group therapies need adaptation for hybrid or online delivery.Peer-led focus groups discussed adapting cognitive remediation group therapy (CRGT) as a hybrid or online intervention.CRGT combines mindfulness-based stress reduction and brain training activities.Purposive sampling recruited people aging with HIV (40+) who self-identified cognitive concerns and resided in two Canadian provinces.Content analysis was employed on transcripts by 7 independent coders.Ten, two-hour focus groups were conducted between August and November 2022.Participant (n=45) demographics included age (M=53.22,SD=7.62) gender (45% women, 42% men, 13% trans/non-binary), sexuality (42% gay, 40% heterosexual, 18% other), ethnicity (45% white, 33% black, 13% Indigenous, 9% mixed-race), and employment (33% employed, 67% retired/disability), and all were retained in care.Overall, participants responded favourably to CRGT's modalities and preferred a hybrid model blending in-person and online interactions.Preferred intervention facilitators were peers and mental health professionals.Knowledge of HIV's impacts on cognitive health, including HIV-associated neurocognitive disorder, was very low despite high reports of cognitive concerns (e.g., trouble remembering, impaired attention, difficulty problemsolving).Given the aging of the HIV population in Canada and the United States, increasing support will be required to improve quality of life.This presentation will discuss a hybrid CRGT adaptation, alongside considerations for how COVID-19 has impacted intervention research.